Rectal Prolapse

Question 1

Define type 1 and type 2 rectal prolapse?

Answer 1

type 1 rectal prolapse= occurs when only rectal mucosa protrudes through the anus

type 2= when all the layers of the rectum protrude through the anus, creating a mass which has palpable, concentric rings

Question 2

outline the aetiology of rectal prolapse?

Answer 2

straining

abnormal rectal activity anatomy or physiology ( eg pelvic floor weakness, poor fixation of rectum to sacrum or reduced anal sphincter pressure)

Question 3

what are the risk factors for rectal prolapse?

Answer 3

constipation

causes of increased straining

cystic fibrosis ( in children) 
previous trauma to anus/perineum

neurological conditions ( Cauda equina syndrome, MS)

Question 4

summarise the epidemiology of rectal prolapse?

Answer 4

relatively common

most affected: children under 3 and ELDERLY

Question 5

What are the presenting symptoms of rectal prolpase?

Answer 5

protruding anal mass

intially associated with defecation

may require digitsl replacement

constipation

faecal incontinence- in 75%

PR mucus or bleeing

may be an EMERGENCY- irreducable or strangulated prolapse

Question 6

what are the signs of rectal prolapse on physical examination?

Answer 6

prolapse may be seen on straining

may be ulcerated or necrotic if vascular supply is compromised

reduced anal sphincter tone

Question 7

what are the 2 main types of imaging used to diagnose rectal prolapse?

Answer 7

Proctosigmoidoscopy

Defecating proctogram or barium enema

Question 8

what other investigations are used for rectal prolapse?

Answer 8

Anal sphincter manometry

Pudendal nerve studies

Sweat Chloride Test-> Performed in children to test for cystic fibrosis